To the Editor:—

A young woman presented for emergency dilation and curettage and requested general anesthesia. She recently had her tongue pierced and currently had a large, metal, barbell-shaped bolt in her tongue. While discussing the placement of the device, the patient relayed anecdotal stories of people swallowing the lower or upper portion in their sleep, even though the bolt was believed to be tightly screwed together. After the anesthetic risks of the tongue piercing were explained to the patient, 1,2she was reluctant to remove the device for fear of having to get her tongue repierced, should the hole close.

After some consideration, I was able to alleviate both of our concerns. The patient removed the jewelry from her tongue, and I was able to easily pass an epidural catheter through the existing hole. I then tied the epidural catheter in a large loop, as not to impinge her tongue (fig. 1)

Fig. 1. Tongue with epidural catheter through piercing hole.

Fig. 1. Tongue with epidural catheter through piercing hole.

. This did not impede laryngoscopy, nor did it cause any trauma to her tongue or teeth. If the piercing is very new, one could also pass the epidural catheter alongside the bolt, through the hole, before the jewelry is removed. Such a procedure can satisfy the anesthesia provider’s concern for safety and potentially spare the patient from having to undergo a second tongue piercing.

1.
Mandabach M, McCann D, Thompson G: Body art: Another concern for the anesthesiologist. A nesthesiology 1998; 88:279–80
2.
Rosenberg A, Young M, Bernstein R, Albert D, Mandabach M, McCann D, Thompson G. Tongue rings: Just say no. A nesthesiology 1998; 89:1279–80